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Pinto RM, Chen Y, Park SE. A client-centered relational framework on barriers to the integration of HIV and substance use services: a systematic review. Harm Reduct J 2019; 16:71. [PMID: 31856845 PMCID: PMC6923912 DOI: 10.1186/s12954-019-0347-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 12/10/2019] [Indexed: 02/08/2023] Open
Abstract
Background Given the close connection between human immunodeficiency virus (HIV) infection and substance use disorder (SUD), access to integrated HIV and SUD services is critical for individuals experiencing both challenges and their biopsychosocial conditions. Method Adopting an integrative method, this systematic review included 23 empirical studies published between 2000 and 2018. Articles investigated providers’ and clients’ perspectives on barriers to accessing integrated HIV and SUD services in various service settings (e.g., HIV primary care, SUD treatment, pharmacy). Results Using a client-centered relational framework, we identified barriers in three relational domains with “the client” as the focus of each: client-provider, client-organization, and client-system. The review shows that (1) barriers to HIV and SUD services do not exist in isolation, but in the dynamics within and across three relational domains; (2) service providers and clients often have different perceptions about what constitutes a barrier and the origin of such barriers; and (3) interprofessional and interorganizational collaborations are crucial for integrating HIV and SUD services. Conclusion This review points out the limitations of the conventional paradigm grouping barriers to service integration into isolated domains (client, provider, organization, or system). Reforms in service arrangements and provider training are recommended to address barriers to integrated services.
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Affiliation(s)
- Rogério Meireles Pinto
- School of Social Work, University of Michigan-Ann Arbor, 1080 South University Avenue, Ann Arbor, MI, 48109, USA.
| | - Yun Chen
- School of Social Work, University of Michigan-Ann Arbor, 1080 South University Avenue, Ann Arbor, MI, 48109, USA
| | - Sunggeun Ethan Park
- School of Social Work, University of Michigan-Ann Arbor, 1080 South University Avenue, Ann Arbor, MI, 48109, USA
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Russell BS, Lincoln CR, Starkweather AR. Distress Tolerance Intervention for Improving Self-Management of Chronic Conditions: A Systematic Review. J Holist Nurs 2018; 37:74-86. [PMID: 29788795 DOI: 10.1177/0898010118777327] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND The inability to tolerate distress can negatively influence effective self-management (SM) of chronic conditions by interfering with the ability to focus on illness needs and impairing problem-solving and prioritizing capabilities, as well as engagement in SM activities. Interventions to increase distress tolerance offer a holistic approach to chronic disease SM and may enhance the individual's ability to apply SM skills and resources to improve quality of life and overall health. The purpose of this systematic review was to deepen understanding of the relationships among distress tolerance and goal-oriented problem-solving as an aspect of chronic disease SM. METHOD The Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations were used to develop a search strategy, selection criteria, screening, and identification and extraction procedures. PubMed, CINAHL, PsychInfo, and Scopus were searched from 2006 to December 2017 using the following search terms: distress tolerance, chronic conditions, self-management. RESULTS Across the 11 studies included in the literature review, there was a high level of heterogeneity in the use of subjective and objective measures to assess distress tolerance, and only one study included instruments to measure goal-oriented problem-solving, the target of distress tolerance interventions that are assumed to influence the selected health outcome. CONCLUSION Further research is needed on the efficacy of distress tolerance interventions for improving SM of chronic conditions. Theory-driven interventions that explicate the precise goal-oriented problem-solving and SM behaviors that are expected to change as a result of the distress tolerance intervention will provide insight on the efficacy of the intervention and help close the theory-practice gap.
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Lubetkin EI, Guidry JA, Webb A, Ocampo A, Burkhalter JE. Examining transdiagnostic vulnerabilities among HIV positive smokers seen at three inner city community based organizations. AIDS Care 2017; 30:140-145. [PMID: 28783955 DOI: 10.1080/09540121.2017.1363366] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Investigators have proposed a "transdiagnostic vulnerability framework" that examines the relationship between smoking and broader emotional factors, including anhedonia, anxiety sensitivity, and distress tolerance. Because smoking and depression are more common in persons living with HIV and AIDS (PLWHA) than in the general population, understanding the relationship between smoking and mental health is critical. The following study aims to characterize levels of clinically significant depressive symptoms and these broader emotional factors as well as the relationship between these factors and smoking-related variables in a sample of PLWHA. This cross-sectional study employed convenience sampling to survey adult clients who attended one of three AIDS service organizations in New York City. The questionnaires assessed sociodemographic and HIV health care variables, tobacco use, and anxiety - and depression-related constructs. 150 PLWHA completed surveys. Among the 118 smokers, the prevalence of clinically depressive symptoms was 53%. Participants with clinically significant depressive symptoms had significantly higher mean anhedonia scores and anxiety sensitivity scores and lower mean distress tolerance total scores compared to participants without clinically significant depressive symptoms (p < 0.001). Smoking cessation treatment for persons with co-morbid psychiatric disorders has been suboptimal and treatment for co-morbid mental health conditions tends to align with disorder-specific treatment. Given that PLWHA are a priority population, further research should address how to best tailor interventions to a group with multiple obstacles to successful tobacco cessation.
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Affiliation(s)
- Erica I Lubetkin
- a Department of Community Health and Social Medicine , CUNY School of Medicine , New York , NY , USA
| | - John A Guidry
- b Gay Men's Health Crisis (GMHC) , New York , NY , USA
| | - Andrew Webb
- c Department of Psychiatry and Behavioral Sciences , Memorial Sloan Kettering Cancer Center , New York , NY , USA
| | - Alex Ocampo
- d Immigrant Health and Cancer Disparities Service , Memorial Sloan Kettering Cancer Center , New York , NY , USA
| | - Jack E Burkhalter
- c Department of Psychiatry and Behavioral Sciences , Memorial Sloan Kettering Cancer Center , New York , NY , USA
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Newman CE, Mao L, Persson A, Holt M, Slavin S, Kidd MR, Post JJ, Wright E, de Wit J. 'Not Until I'm Absolutely Half-Dead and Have To:' Accounting for Non-Use of Antiretroviral Therapy in Semi-Structured Interviews with People Living with HIV in Australia. AIDS Patient Care STDS 2015; 29:267-78. [PMID: 25806574 DOI: 10.1089/apc.2014.0301] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Current debates regarding the use of antiretroviral therapy (ART) to promote both individual- and population-level health benefits underscore the importance of understanding why a subpopulation of people with diagnosed HIV and access to treatment choose not to use it. Semi-structured interviews were conducted between 2012 and 2014 with 27 people living with HIV in Australia who were not using ART at the time of interview. Analytic triangulation permitted an appreciation of not only the varied personal reasons for non-use of treatment, but also underlying views on HIV treatment, and the ideal conditions imagined necessary for treatment initiation. Policy goals to increase the number of people with HIV using ART must recognize the diverse explanations for non-use of ART, which include concerns about the various impacts of committing to lifelong pharmaceutical treatment use. Our research identified distinctive subgroups among people who are not using antiretroviral therapy, with a range of individual and social needs that may affect treatment decisions. These findings challenge assumptions about treatment non-use in resource-rich settings, revealing persistent consumer fears about the potent and unknown effects of HIV medications that deserve greater recognition in policy debate on treatment uptake.
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Affiliation(s)
- Christy E. Newman
- Centre for Social Research in Health, UNSW Australia, Sydney, Australia
| | - Limin Mao
- Centre for Social Research in Health, UNSW Australia, Sydney, Australia
| | - Asha Persson
- Centre for Social Research in Health, UNSW Australia, Sydney, Australia
| | - Martin Holt
- Centre for Social Research in Health, UNSW Australia, Sydney, Australia
| | - Sean Slavin
- Australian Federation of AIDS Organisations, Sydney, Australia
| | - Michael R. Kidd
- Faculty of Medicine, Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Jeffrey J. Post
- Department of Infectious Diseases, The Prince of Wales Hospital, Sydney, Australia
- Prince of Wales Clinical School, UNSW Australia, Sydney, Australia
| | - Edwina Wright
- Department of Infectious Diseases, The Alfred Hospital and Monash University, Melbourne, Australia
- The Burnet Institute, Melbourne, Australia
| | - John de Wit
- Centre for Social Research in Health, UNSW Australia, Sydney, Australia
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Adedinsewo DA, Wei SC, Robertson M, Rose C, Johnson CH, Dombrowski J, Skarbinski J. Timing of antiretroviral therapy initiation in a nationally representative sample of HIV-infected adults receiving medical care in the United States. AIDS Patient Care STDS 2014; 28:613-21. [PMID: 25329710 PMCID: PMC4250960 DOI: 10.1089/apc.2014.0194] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Early antiretroviral therapy (ART) initiation reduces the risk of disease progression and HIV transmission, but data on time from HIV care entry to ART initiation are lacking. Using data from the Medical Monitoring Project (MMP), a population-based probability sample of HIV-infected adults receiving medical care in the United States, we assessed time from care entry to ART initiation among persons diagnosed May 2004-April 2009 and used multivariable Cox proportional-hazards models to identify factors associated with time to ART initiation. Among 1094 MMP participants, 83.9% reported initiating ART, with median time to ART initiation of 10 months. In multivariable models, blacks compared to whites [hazard ratio (HR) 0.82; 95% confidence interval (CI) 0.70-0.98], persons without continuous health insurance (HR 0.82; CI 0.70-0.97), heterosexual women and men who have sex with men compared to heterosexual men (HR 0.66; CI 0.51-0.85 and HR 0.71; CI 0.60-0.84, respectively), and persons without AIDS at care entry (HR 0.37; CI 0.31-0.43) had significantly longer times to ART initiation. Overall, time to ART initiation was suboptimal by current standards and significant disparities were noted among certain subgroups. Efforts to encourage prompt ART initiation should address delays among those without health insurance and among certain sociodemographic subgroups.
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Affiliation(s)
- Demilade A. Adedinsewo
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee
- National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Stanley C. Wei
- National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
- US Public Health Service, Atlanta, Georgia
| | - McKaylee Robertson
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee
- National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Charles Rose
- National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Christopher H. Johnson
- National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Julie Dombrowski
- Department of Medicine, University of Washington, Seattle, Washington
- Public health—Seattle and King County HIV/STD Program, Seattle, Washington
| | - Jacek Skarbinski
- National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
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Levi-Minzi MA, Surratt HL. HIV stigma among substance abusing people living with HIV/AIDS: implications for HIV treatment. AIDS Patient Care STDS 2014; 28:442-51. [PMID: 24983302 DOI: 10.1089/apc.2014.0076] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
HIV-related stigma has a major impact on quality of life and health among people living with HIV and AIDS (PLWHA). This study examines demographic, mental health, behavioral, contextual, and HIV care-related correlates of HIV stigma among 503 substance abusing PLWHA. Stigma was measured with the HIV Internalized Stigma Measure which has four subscales: stereotypes about HIV, self-acceptance, disclosure concerns, and social relationships. Severe substance dependence (55.3%) and depression (54.7%) were associated with higher HIV stigma across all domains. 49.9% of the sample reported antiretroviral (ARV) medication diversion (the unlawful sale and trading of ARV medications); diverters endorsed significantly higher stigma related to disclosure. 54.1% of the sample reported ≥95% ARV adherence; these individuals reported significantly lower stigma for self-acceptance, disclosure, and social relationships. Multivariate linear regression showed that depression and social support demonstrated significant main effects across stigma domains. Findings suggest that interventions to decrease HIV related stigma may be an important component of initiatives to increase engagement in HIV care.
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Affiliation(s)
- Maria A. Levi-Minzi
- Center for Applied Research on Substance Use and Health Disparities, Nova Southeastern University, Miami, Florida
| | - Hilary L. Surratt
- Center for Applied Research on Substance Use and Health Disparities, Nova Southeastern University, Miami, Florida
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